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Dose coverage of axillary level I-III areas during whole breast irradiation with simplified intensity modulated radiation therapy in early stage breast cancer patients

2015; Impact Journals LLC; Volume: 6; Issue: 20 Linguagem: Inglês

10.18632/oncotarget.4301

1949-2553

Li Zhang, Zhao-Zhi Yang, Xing-xing Chen, Jeffrey Tuan, Jin-li Ma, Xin Mei, Xiao-Li Yu, Zhi-Rui Zhou, Zhi-Min Shao, Guang‐Yu Liu, Xiao-Mao Guo,

Breast Lesions and Carcinomas

// Li Zhang 1,* , Zhao-zhi Yang 1,* , Xing-xing Chen 1,* , Jeffrey Tuan 3 , Jin-li Ma 1 , Xin Mei 1 , Xiao-li Yu 1 , Zhi-rui Zhou 1 , Zhi-min Shao 2 , Guang-yu Liu 2 and Xiao-mao Guo 1 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China 2 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China 3 Department of Radiation Oncology, National Cancer Centre Singapore, Singapore * These authors have contributed equally to this work Correspondence to: Guang-yu Liu, email: // Xiao-mao Guo, email: // Keywords : breast cancer; positive sentinel lymph nodes, radiotherapy, intensity modulated radiation therapy, axillary level Received : March 27, 2015 Accepted : May 18, 2015 Published : May 27, 2015 Abstract Purpose: This study was designed to evaluate the dose coverage of axillary areas during whole breast irradiation with simplified intensity modulated radiation therapy (s-IMRT) and field-in-field IMRT (for-IMRT) in early stage breast cancer patients. Methods: Sixty-one consecutive patients with breast-conserving surgery and sentinel lymph node biopsy were collected. Two plans were created for each patient: the s-IMRT and for-IMRT plan. Dosimetric parameters of axillary areas were compared. Results: The average of mean doses delivered to the axillary level I areas in s-IMRT and for-IMRT plan were 27.7Gy and 29.1Gy ( p = 0.011), respectively. The average of V47.5Gy, V45Gy and V40Gy (percent volume receiving≥ 47.5Gy, 45Gy and 40Gy) of the axillary level I in s-IMRT plan was significantly lower than that in for-IMRT plan ( p < 0.001). For for-IMRT plans, patients with upper tangential border to humeral head ≤2cm, breast separation >19.3cm and body width >31.9cm had significantly higher mean dose in axillary level I area ( p = 0.002, 0.007, 0.001, respectively). Conclusion: Compared with for-IMRT plan, the s-IMRT plan delivered lower dose to axillary level I area. For centers using s-IMRT technique, caution should be exercised when selecting to omit axillary lymph node dissection for patients with breast conserving surgery and limited positive SLNs.